To Donna and others,

Just thought I'd add my 2 cents here...we have seen a fair number of these
babies (usually boys) in our hospital outpatient clinic.  It's very important to
get mom pumping with a rental-type  pump ASAP to establish her milk supply.
(Ideally, she would have left the hospital with one)  I agree with Judy that the
first rule here is to feed the baby enough calories so he will have the energy
to nurse.  In the limited amount of time we have with moms, this would be our
usual care plan in such a  situation:    Pump with L------- every 2 to 3 hours
to increase milk supply, feed pumped milk to baby by cup or bottle with N - k
nipple followed by ABM to total 1-1/2 to 2 oz.  so that baby is having
appropriate number of wet diapers/stools. After  milk is "in" if baby is still
refusing, we would try the temporary use of a M-----nipple shield to give baby
help in coordinating his suck at breast.  This is almost always successful once
mom's breasts are full of milk.  After baby masters nursing with the shield and
is eating/gaining/wetting/stooling appropriately, mom can wean him off by
slipping it off soon after baby begins to nurse well or  use it only at some
feeds when baby is in no mood  to latch without it.**   (I know there are some
who do not approve of the use of a nipple shield but we have had good results in
these specific kinds of cases where mom would have given up and gone to bottle
feeding if something didn't happen really soon.)

I would be very leery of sending a mom home with an SNS to finger-feed only 15
cc of milk to an already weakened baby with an incoordinated suck.  The
pediatricians in our town would not be comfortable with that, and I (especially
as a non-RN !!!!!) would lose respect in their eyes for suggesting it.  In
closing, we would also follow this mom up very closely until everyone is
comfortable with how she and baby are doing.

**P.S.  The longest use I can remember is 4 months.  Baby gained beautifully,
and still using the shield at about 4 months (according to mom)  began a feeding
one day, drew her head back back and then put her little hand up, removed it
herself and resumed nursing.  She is about 8 months old now and still nursing
...without a shield!

Diane Bechtel, IBCLC
Indiana